Provider Demographics
NPI:1295196624
Name:HALLOCK, ESTHER KIA (CRNA)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:KIA
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:KIA
Other - Last Name:WERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:616 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2845
Mailing Address - Country:US
Mailing Address - Phone:904-955-5635
Mailing Address - Fax:
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712114367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered